Mgr, Pat Access Fncl Clearance

Phoenix Children's Hospital, Inc.; Phoenix (AZ); Remote; USD 90,000 - 120,000; Full time

Job summary

Phoenix Children's Hospital, Inc. seeks a Manager of Patient Access Financial Clearance to lead pre-registration, payer authorization, and financial counseling. You will supervise staff, ensure data quality, and optimize reimbursement across inpatient and outpatient settings. Collaborate with payors and hospital departments to improve efficiency and compliance.

The role emphasizes leadership, process improvement and cross-functional coordination within a large pediatric health system.

Qualifications

• Bachelor's degree in business or related field or equivalent experience.
• 5+ years of management/leadership experience in healthcare settings.
• Experience with payer authorization, pre-registration, financial counseling, and revenue-cycle concepts.
• Knowledge of CPT/ICD-9 codes and HIPAA/privacy basics is preferred.

Responsibilities

• Provide strategic leadership and manage staff for financial clearance functions.
• Develop goals, priorities and assign tasks for front-end patient access teams.
• Monitor KPIs, productivity and QA measures; report to Director.
• Oversee enrollment data quality, payer authorizations and outreach to payors.
• Collaborate with other departments to standardize processes and improve flow.

Skills

Leadership

Staff management

Budgeting

Process improvement

Data analysis

Regulatory/compliance

Education

Bachelor's in Business or related field

Tools

AMPFM or Misys platform

Job description

Location: Telecommuting

Shift: Mon-Fri, Days, 8am-5pm

Category: Director/Management

Employee Type: Full-Time

Position Summary

The Manager of Patient Access Financial Clearance is responsible for planning, organizing, leading and directing the overall financial clearance functions, which includes pre-registration, payer authorization (outpatient and hospital) and financial counseling functions where applicable, for optimal performance of the front-end patient financial clearance process. In addition, the Manager oversees and is accountable for front-end data quality for the pre-registration, payer authorization (outpatient and hospital) and financial counseling activities for Patient Access scope of service. Ensures an ongoing procedure for accurate and timely gathering of patient information, securing patient`s insurance coverage limits and benefits and communicating to patients for meeting the financial expectations of the hospital as applicable. Ensures that these functions are performed efficiently throughout the enterprise, which includes maintaining an adequately trained staff to handle all patients in both inpatient and outpatient clinic settings. The manager must have a clear understanding of multiple managed care contracts, multiple specialty insurance and billing practices, and exercise professional competency in reviewing patient accounts to maximize reimbursement and minimize financial risk to Phoenix Children’s. Successful oversight will result in increased net revenues by reducing bad debt from potential write-offs due to lack of patient collections and denials. Interactions will primarily be conducted with both patients and payors and results of efforts will drive actions to secure payment for scheduled and unscheduled patients. Serves as a resource to faculty, managers, and clinic staff in all financial clearance related issues.

Position Duties

Leadership/Management

• Provides effective leadership and manages appropriate staff levels. Develops goals and priorities and assigns tasks and projects.
• Develops staff skills and training plans.
• Counsels, trains and coaches assigned staff.
• Implements corrective actions and conducts performance evaluations.
• Provides leadership, direction and guidance.
• Represents the department on various committees.
• Responsible for designing, developing, and monitoring performance improvement processes such as but not limited to quality, accuracy, productivity and timeliness.
• Manages implementation of standards and systems to enhance quality, consistency, efficiency, and timeliness of responsibilities for the enterprise.
• Monitors to ensure that integrity and accuracy of registration data is maintained by the staff supervised.
• Works collaboratively with other departments to ensure the processes and systems for patient financial clearance processes are standardized and optimized for efficient and effective flow of patients within the department and the organization.
• In conjunction with Supervisors, ensures staff are scheduled appropriately and in accordance with volume and workflow indicators to ensure compliance with department goals.
• Manages daily operations of the Financial Clearance team to ensure optimal efficiency of workflow processes consistent with all applicable standards and regulations, and established policies and procedures.
• Develops and continually refines policies and procedures; i.e., No Surprise Act and Good Faith Estimate processes.
• Participates in the budget process and recommends appropriate purchase of equipment and systems.
• Monitors and trends Key Performance Indicators and Productivity and QA measures for the Financial Clearance and reports results, progress and recommendations to Director.
• Provides timely review and feedback to management team for fiscal responsibilities of designated areas, reflecting optimal use of all resources.
• Responsible for the supervision of a team of nurses who act as resources to resolve Authorization issues.

Subject Matter Expertise

• Ensures financial clearance functions are performed efficiently throughout the Patient Access services enterprise.
• Financial Clearance functions include but are not limited to, pre-registration tasks such as, insurance verification, insurance benefits data, regulatory requirements, securing payer authorizations, collecting payments for upcoming services to financially secure all applicable accounts.
• Oversees timely financial assistance application approval process consistent with state and federal requirements and recommendations.
• Provides financial clearance service approach for patients and family from point of contact through charging. Strives to provide services that exceed expectations and works to eliminate barriers to good service. Maintains relations with all internal applicable parties, third party payers, and other agencies, as appropriate.
• Serves as a resource for staff to identify appropriate protocols regarding specific health plan criteria. Facilitates interaction with health plan, as necessary, to ensure compliance with current authorization guidelines and requirements.

Innovation and Growth

• Identifies revenue cycle issues and provide leadership for root cause analysis and problem resolution.
• Designs and implements appropriate plans to meet goals.
• Supports the Director in developing strategies for operational improvement, assists with budget development, and departmental reporting.
• Participates in various facility and system-wide process improvement teams.
• Works closely and cooperatively with other areas and departments of PCMG and the hospital to identify issues, concerns and areas for increased efficiencies to develop effective integrated solutions.

Performs miscellaneous job related duties as requested.

Phoenix Children's Mission, Vision, & Values

Mission

To advance hope, healing and the best healthcare for children and their families

Vision

Phoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.

We realize this vision by:

• Offering the most comprehensive care across ages, communities and specialties
• Investing in innovative research, including emerging treatments, tools and technologies
• Advancing education and training to shape the next generation of clinical leaders
• Advocating for the health and well-being of children and families

Values

• We place children and families at the center of all we do
• We deliver exceptional care, every day and in every way
• We collaborate with colleagues, partners and communities to amplify our impact
• We set the standards of pediatric healthcare today, and innovate for the future
• We are accountable for making the highest quality care accessible and affordable

Position Qualifications

Education

• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 1. Bachelors in Business or related field OR combination of equivalent education and experience (Required)

Experience

• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 1. Five (5) years of management and/or leadership experience. (Required)
• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 2. Seven (7) years of related healthcare experience, which includes a minimum of two (2) years of experience in a hospital and professional registration, insurance verification and authorization, financial counseling department. (Required)
• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 3. AMPFM or Misys platform experience. (Preferred)

Special Skills

• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 1. Ability to work effectively in a high-volume, fast-paced environment with changing priorities. (Required)
• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 2. Must possess customer-focused attitude and professional demeanor. (Required)
• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 3. Analytical skills associated with generating productivity and other related reports. (Required)
• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 4. Knowledge of CPT/ICD-9 codes and an understanding of medical terminology and HIPAA privacy laws. (Required)
• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 5. Strong/effective oral and written communication and problem-solving skills. (Required)
• Do you meet this requirement or have the ability to obtain it within the timeframe listed in the requirement? 6. Follow any payer or governmental requirement as required by the organization. (Required)

Physical Requirements & Occupational Exposure/Risk Potential

• Physical Requirement - Climbing - Occasionally
• Physical Requirement - Fine Motor Skills (pinching, gripping, etc) - Occasionally
• Physical Requirement - Hearing - Frequently
• Physical Requirement - Pushing/pulling - Occasionally
• Physical Requirement - Reaching - Occasionally
• Physical Requirement - Sitting - Frequently
• Physical Requirement - Standing - Occasionally
• Physical Requirement - Stooping/crouching/kneeling/crawling - Occasionally
• Physical Requirement - Talking - Frequently
• Physical Requirement - Tasting/smelling - Occasionally
• Physical Requirement - Walking - Frequently
• Physical Requirement - Near Vision - Occasionally
• Physical Requirement - Far Vision - Occasionally
• Physical Requirement - Color Discrimination - Occasionally
• Physical Requirement - Use of keyboard, mouse and/or computer equipment - Constantly
• Physical Requirement - Lift up to 35 pounds without assistance - Occasionally
• Physical Requirement - Lift more than 35 pounds without assistance - Occasionally
• Occupational Exposure/Risk Potential - Inside office environment - Applicable
• Occupational Exposure/Risk Potential - Confined areas - Applicable